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NPI Code Detail

MEDICARE: JONATHAN MCCUTCHEN ATC

MEDICARE: JONATHAN MCCUTCHEN ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2013039015MO

General Provider Information

NPI Number : 1932564614
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MCCUTCHEN ATC
Provider Business Mailing Address
First Line : 5398 PERSHING AVE APT 3E
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63112-1788
Country : US
Telephone Number : 314-809-8519
Fax Number :
Provider Business Practice Location Address
First Line : 4970 OAKLAND AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-1402
Country : US
Telephone Number : 314-809-8519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2015
Last Update Date : 12/22/2015

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Directions to “ JONATHAN MCCUTCHEN ATC” Practice Location

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